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Doctors' salaries still an issue

WITH less than a week left before the mass resignation of doctors in Slovakia’s state-run hospitals is due to take effect, the Medical Trade Unions Association (LOZ) and the government have failed to reach an agreement to prevent the protest action that has been raising fear among Slovaks for over two months. The cabinet says that the only issue now separating the two parties is doctors’ salaries, while the doctors have countered that they remain ready to find a compromise solution.

WITH less than a week left before the mass resignation of doctors in Slovakia’s state-run hospitals is due to take effect, the Medical Trade Unions Association (LOZ) and the government have failed to reach an agreement to prevent the protest action that has been raising fear among Slovaks for over two months. The cabinet says that the only issue now separating the two parties is doctors’ salaries, while the doctors have countered that they remain ready to find a compromise solution.

The Health Ministry is preparing crisis plans for the hospitals that may become short-staffed in December, and Slovakia’s president has said he will ask the government to declare a national state of emergency and thereby force doctors to continue working if an agreement is not reached through negotiation.

LOZ launched its protest in late September by collecting notices from doctors to terminate their employment contracts with the hospitals as of December 1. Over 2,400 doctors agreed to submit such notices.

The doctors have set out four demands: a halt to the process of transforming state-run hospitals into joint-stock companies; for the hospitals to comply with the Labour Code on doctors’ hours of work and other working conditions; for the government to increase funding for health-care facilities; and for the salaries of doctors to be gradually increased based on a formula connected to average salaries in Slovakia.

After the fall of the government of Iveta Radičová in mid October the process of changing the legal status of the 31 hospitals was suspended until a new government takes office after the March general election. But the doctors did not end their protest at that point and insisted that what they call a crisis in Slovakia’s health-care system could be resolved only if agreement was reached on all four issues.

€300 salary rise rejected

Despite previous statements that the state had no resources for doctors’ pay rises, Health Minister Ivan Uhliarik proposed in a memorandum on November 17 to increase their salaries by €300 and to cover other issues such as anti-corruption measures and a code of ethics for physicians.

“This is the maximum the state can afford and thus it’s a final offer,” Uhliarik stated in a news release, repeating his call that the doctors must stop threatening the health of their patients.The doctors’ union rejected the minister’s proposed memorandum and presented its own version in which they asked the cabinet to propose a law by November 24 that would definitively stop the transformation of the hospitals and establish anti-corruption measures and a code of ethics.

While the minister had pledged in his memorandum to ask the directors of all the hospitals to re-employ the doctors who have filed resignation notices, LOZ’s counterproposal went further, demanding that all doctors be returned to the positions they held before submitting notices and seeking assurance that no negative actions would be taken against any of the doctors because of their participation in the protest.

What appears now to be the biggest bone of contention between the parties is salary levels, with LOZ rejecting Uhliarik’s offer of a €200 pay rise from January 1, 2012, followed by an additional increase of €100 on October 1, 2012. The doctors’ current proposal is for a legislated guarantee that doctors’ base salaries will gradually increase so that they are between 1.5 and three times the average salary in Slovakia, depending on the doctor’s education and experience, on or before January 1, 2013.

“This is a Greek path that Slovakia cannot afford [to take],” Uhliarik had earlier said about the doctors’ salary demands. The ministry had calculated that doctors’ base salaries would increase by €600 to €1,300 per month under the union’s proposal.

The minister also told the media that “LOZ head Marián Kollár will be fully responsible for children and patients who will be left alone by the doctors on December 1, 2011” if the doctors do not sign the memorandum for the €300 salary increase proposed by the ministry.

Some doctors have withdrawn their resignation notices, with the hospital in Piešťany reporting that 21 of the 23 doctors who had submitted resignations had withdrawn them.

“It all turned around so that patients are becoming hostages of the doctors in this fight,” said Piešťany orthopaedic doctor Peter Ottinger, one of those who withdrew his resignation, as quoted by the TASR newswire, adding that he believes LOZ’s pressure is no longer appropriate and that it is losing support among doctors, particularly in regional areas.

Declaration of emergency

The Health Ministry and LOZ held marathon talks during late November, including a six-hour meeting on November 21 that lasted long into the night but failed to bring much progress.

Some observers had expected LOZ to reach agreement with the government after the doctors’ meeting with Prime Minister Iveta Radičová on the evening of November 23. Nevertheless, President Ivan Gašparovič stepped into the fray and announced after his earlier meeting with LOZ representatives on November 23 that he was considering asking the government to declare a state of emergency effective December 1 if the doctors did not withdraw their resignation notices.

According to Slovakia’s constitutional law on state security, the government can declare a state of emergency in times of war or under certain other conditions such as when citizens’ lives or health are in danger. The law permits a state of emergency to last no longer than 90 days.

Declaration of a state of emergency would mean that doctors who submitted resignations could be forced to continue to work at their hospitals after December 1 since the law specifically allows the government to restrict citizens’ personal freedoms to a limited extent, meaning the government could order the doctors to perform their duties. The doctors would be paid 30-percent less than their normal salaries and refusal to comply with such an emergency order would be a criminal act.

In a similar move in December 2010 the Spanish government declared a “state of alert” for 15 days and threatened air traffic controllers with prison sentences if they continued their action of calling-in sick, en masse. The controllers staged their ‘sick-out’ after the government approved a package of austerity measures, including steps to partially privatise airports and transfer management of Madrid and Barcelona airports to the private sector, according to the BBC website, which added that Spain had not seen such emergency measures since the Franco dictatorship.

President Gašparovič said he will ask the cabinet to announce a state of emergency if the government and LOZ do not reach an agreement by November 26.

Quarrel over salaries

The union leaders from LOZ met with Uhliarik and Prime Minister Radičová on November 23 but they did not leave the meeting with an agreement that the doctors would keep working after December 1. The cabinet pledged to propose an amendment to the law that authorised the transformation of the state-run hospitals into joint-stock companies, in order to completely halt the process – one of LOZ’s key demands.

It now appears that doctors’ salaries are the only major unresolved issue.

“We came with a compromise solution and we proposed further compromise during the negotiations; unfortunately from the cabinet we got their first and last offer,” a LOZ representative told a press conference after the meeting with Uhliarik and Radičová on November 23.

“This is unbelievable, I don’t even want to comment on this so that we have a chance to sit at the negotiating table on Friday,” Radičová responded. She said that the union representative’s statement was unfair and that LOZ had only reiterated its previous salary demand.

The meeting scheduled for Friday, November 25 is the last opportunity for the cabinet and the doctors to find a compromise before the deadline set by President Gašparovič for requesting a state of emergency. The heads of regional organisations of LOZ were scheduled to meet on November 24 to discuss their position but no further information on its outcome was available when The Slovak Spectator went to press the same day.